Use Of Protocol Research Articles

An at-home, virtually administered graded exertion protocol for use in concussion management: Preliminary evaluation of safety and feasibility in healthy youth and children with subacute concussion.

Graded exertion testing (GXT) is an important tool for concussion management, as it is used to personalize post-concussion exercise prescription and return athletes to sport. However, most GXT requires expensive equipment and in-person supervision. Our objective was to assess the safety and feasibility of the Montreal Virtual Exertion (MOVE) protocol, a no-equipment, virtually compatible GXT, in healthy children and children with subacute concussion. Cross-sectional. The MOVE protocol consists of seven stages of bodyweight and plyometric exercises performed for 60 seconds each. Twenty healthy (i.e., non-concussed) children completed the MOVE protocol virtually over Zoom Enterprise. Next, thirty children with subacute concussion (median: 31.5 days post-injury) were randomized to the MOVE protocol or Buffalo Concussion Treadmill Test (BCTT), which increases the incline or speed of the treadmill every minute until maximum exertion. Out of an abundance of caution, all concussed participants completed the MOVE protocol in an in-person clinical space. However, the test evaluator was stationed in a different room within the clinic and administered the MOVE protocol using Zoom Enterprise software to mimic telehealth conditions. Safety and feasibility outcomes were recorded throughout GXT, including heart rate, rate of perceived exertion (RPE), and symptom outcomes. No adverse events were recorded, and all feasibility criteria were successfully met in healthy youth and youth with concussion. Among concussed youth, increases in heart rate (MOVE: 82.4  17.9 bpm, BCTT: 72.1  23.0 bpm; t(28)=1.36, p=0.18), RPE (MOVE: 5.87  1.92, BCTT: 5.07  2.34, t(28)=1.02, p=0.32), and overall symptom presentation were similar between the MOVE and BCTT protocols. The MOVE protocol is a safe and feasible GXT that in healthy youth and youth with subacute concussion. Future studies should assess the fully virtual administration of the MOVE in children with concussion, MOVE protocol tolerability in children with acute concussion, and whether the MOVE protocol can be used to guide individualized exercise prescription.

Effectiveness of a hypertension management protocol in rural Haitian adults and pregnant women

BackgroundHaiti's hypertension prevalence among adults ≥40 years of age is nearly twice that of nations in the Americas. Haiti Health Initiative (HHI) developed a hypertension management protocol for use in outreach clinics in Timo, a rural mountainous community in Haiti. This study aimed to evaluate the effectiveness of the hypertension protocol for treating adults ≥40 years of age and pregnant women with severe hypertension. MethodsThis retrospective longitudinal study included 209 patients across 1148 clinic visits/encounters. De-identified medical records from 11 biannual outreach clinics between April 2014 to April 2019 were reviewed for analysis. Descriptive statistics, paired t-tests, and multilevel models were performed. The primary outcome was systolic and diastolic blood pressure measurements at each clinic visit. FindingsIn the study (n = 1148 visits), hypertension and severe hypertension prevalence were respectively 79·8% and 38·4%. Multilevel models showed a decrease of 0·29 mmHg (p = 0·37) in systolic blood pressure and a decrease in diastolic blood pressure of 0·66 mmHg (p < 0·001) per visit. Individual factors and protocol adherence did not predict a reduction in blood pressure. ConclusionEffective management of hypertension and other chronic conditions among hard-to-reach populations with limited healthcare access requires comprehensive outreach efforts that address care antecedents, structures, and processes. Although outreach clinics made treatment accessible to vulnerable populations, the protocol, which used medications with previously demonstrated efficacy, had little impact on reducing blood pressure in patients with severe hypertension.

Implementation of neonatal phototherapy with the BiliCocoon Bag® device in the maternity ward and impact on mother–infant separation

BackgroundFree bilirubin jaundice is a frequent pathology in the neonatal period. The major complication is neurological toxicity, the most severe form of which is kernicterus. Overall, 5%–10% of jaundiced neonates require treatment. The first-line treatment is phototherapy, with intensive phototherapy being the gold standard. Other equipment is also available, including the BiliCocoon Bag®. It is a safe and controlled therapy that can be performed in the mother's room in the maternity ward, thereby avoiding separation and allowing for breast- or bottle-feeding during treatment. It is easy to install and does not require protective glasses, thus no scope or hospitalization. In our maternity ward, all neonates requiring intensive phototherapy are hospitalized in the neonatology ward. ObjectiveThe objective of our study was to evaluate the number of avoided hospitalizations in neonatology for free bilirubin jaundice since the introduction, according to a strict protocol, of the BiliCocoon Bag® device. Material and MethodThis was a single-center retrospective cohort study using data of newborns usually collected as part of standard care. Children born in our maternity ward during an 18-month period (August 1, 2020 to January 31, 2022) were included. Causes of jaundice, age at the beginning and mode of treatment, number of sessions for each device, and length of stay were compared. Results are presented as number and percentage with median (25th–75th) or mean (extremes) values for categorical and continuous variables, respectively. A t-test was used to compare the means of the independent groups. ResultsA total of 316 newborns were included. Physiological jaundice was the main cause of jaundice. The median age for the first phototherapy treatment was 54.5 h (30–68). The 316 neonates needed 438 phototherapy sessions: 235 (74%) neonates required only one phototherapy session, 85 (36%) of them were treated with the BiliCocoon Bag®. For the 81 children who needed two or more phototherapy sessions, 19 children (23.5%) were treated by tunnel phototherapy and then the BiliCocoon Bag®, and eight children (10%) by BiliCocoon Bag® alone. The BiliCocoon Bag® enabled a relative reduction in the hospitalization rate of 38% and avoided hospitalization for approximately one third of the newborns treated. The BiliCocoon Bag® failure rate was 3.6% and the average length of stay was comparable between the two types of treatment. ConclusionFollowing a strict protocol of use, the BiliCocoon Bag® is a reliable method and a good alternative to intensive phototherapy for newborns in the maternity ward, as it avoids hospitalization and mother–infant separation.

Need for palliative care from birth to infancy in pediatric patients with neurological diseases.

Palliative care is a comprehensive treatment approach that guarantees comfort for pediatric patients and their families from diagnosis to death. The techniques used for neurological patients in the field of palliative care can enhance the quality of care provided to patients with neurological disorders and support their families. This study aimed to analyze the palliative care protocols in use in our department, describe the palliative course in the clinical setting, and propose the implementation of hospital palliative care for long-term prognosis of patients with neurological diseases. This retrospective observational study examined the application of palliative care from birth to early infancy in neurological patients. We studied 34 newborns with diseases affecting the nervous system impairing prognosis. The study was conducted from 2016 to 2020 at the Neonatology Intensive Care Unit and the Pediatric Unit of the San Marco University Hospital in Catania, Sicily, Italy. Despite current legislation in Italy, no palliative care network has been activated to meet the needs of the population. In our center, given the vast number of patients with neurological conditions requiring palliative care, we should activate a straightforward departmental unit for neurologic pediatric palliative care. The establishment of specialized reference centers that manage significant neurological illnesses is due to neuroscience research progress in recent decades. Integration with specialized palliative care is sparse but now seems essential.

Feasibility of internal-source tracking with C-arm CT/SPECT imaging with limited-angle projection data for online in vivo dose verification in brachytherapy: A Monte Carlo simulation study

PURPOSEThe current protocol for use of the image-guided adaptive brachytherapy (IGABT) procedure entails transport of a patient between the treatment room and the 3-D tomographic imaging room after implantation of the applicators in the body, which movement can cause position displacement of the applicator. Moreover, it is not possible to track 3-D radioactive source movement inside the body, even though there can be significant inter- and intra-fractional patient-setup changes. In this paper, therefore, we propose an online single-photon emission computed tomography (SPECT) imaging technique with a combined C-arm fluoroscopy X-ray system and attachable parallel-hole collimator for internal radioactive source tracking of every source position in the applicator. METHODS AND MATERIALSIn the present study, using Geant4 Monte Carlo (MC) simulation, the feasibility of high-energy gamma detection with a flat-panel detector for X-ray imaging was assessed. Further, a parallel-hole collimator geometry was designed based on an evaluation of projection image quality for a 192Ir point source, and 3-D limited-angle SPECT-image-based source-tracking performances were evaluated for various source intensities and positions. RESULTSThe detector module attached to the collimator could discriminate the 192Ir point source with about 3.4% detection efficiency when including the total counts in the entire deposited energy region. As the result of collimator optimization, hole size, thickness, and length were determined to be 0.5, 0.2, and 45 mm, respectively. Accordingly, the source intensities and positions also were successfully tracked with the 3-D SPECT imaging system when the C-arm was rotated within 110° in 2 seconds. CONCLUSIONSWe expect that this system can be effectively implemented for online IGABT and in vivo patient dose verification.

Proteinase K Pretreatment for the Quantitative Recovery and Sensitive Detection of the Tuberculosis Biomarker Mannose-Capped Lipoarabinomannan Spiked into Human Serum.

This paper reports on an investigation of an enzymatic pretreatment protocol using proteinase K (ProK) for the analysis of human serum samples spiked with mannose-capped lipoarabinomannan (ManLAM). ManLAM is an antigenic biomarker found in the serum, urine, and other body fluids of individuals infected with tuberculosis (TB). Immunometric measurements of ManLAM are compromised by steric effects due to its complexation with high-molecular-weight components in these matrices that interfere with its capture and/or labeling. Recent work has shown that deproteinization of these types of samples by perchloric acid acidification or ProK digestion releases ManLAM from complexation. Releasing ManLAM greatly improves its detectability and, as a result, its utility as a TB biomarker. The work detailed herein examined how different ProK reaction conditions (e.g., enzyme concentration and digestion time and temperature) affect the recovery and detectability of ManLAM in human serum. As measured by enzyme-linked immunosorbent assay (ELISA), we show that using the optimal set of digestion conditions to free ManLAM, which also yield a small, quantitatively reproducible level of sample concentration, it is possible to achieve a spiked ManLAM recovery of 98 ± 13% and a limit of detection of 10 pg/mL (0.6 pM). Experiments also demonstrated that the ELISA responses measured for a given ManLAM concentration in serum after pretreatment were statistically indistinguishable from those directly determined for the same amounts of ManLAM added to an innocuous buffered solution. Possible adaptations of the digestion protocol for use in point-of-care TB testing are also briefly discussed.

Evaluation of different platelet-rich plasma protocols for use in the equine reproductive clinic

Platelet-rich plasma (PRP) is a biological product used in equine regenerative medicine., Several methods and protocols for obtaining the different forms of PRP exist, depending on the application. In reproductive medicine, there is a need to classify the product according to the number of leukocytes, erythrocytes, and platelets present in PRP. This evaluation allows the classification of pure plasma rich in platelets (P-PRP) or plasma rich in leukocytes and platelets (L-PRP) and not just with the generic name of PRP. The objective of this study was to evaluate the concentration of platelets, erythrocytes, leukocytes, and bacterial load present in PRP, produced by two protocols already used in the equine reproductive clinic and two new protocols that aimed for greater efficiency/simplicity in the separation process. Ten horses of different breeds were selected, and from each one, five total blood samples were collected by venipuncture: one for the complete blood count and four protocols to produce PRP using different protocols (P1, P2, P3, and P4). In P1 and P2, the blood was collected in a vacutainer (4 mL glass tubes) with sodium citrate at 3.2%. P3 and P4 blood collections were in an open system into 50 mL conical plastic tubes using sodium citrate at 3.2% and citrate-phosphate-dextrose adenine (CPDA-1) at 14%, respectively. P1 used 120g/ 10 min centrifugation, and P2 performed two centrifugations, one at 120g / 10min and the other at 240g / 10 min. In both protocols, P3 and P4 used two centrifugations (215g / 10 min and 863g / 10 min). Analysis of blood components and bacterial growth was performed. Protocols were considered independent factors, and platelet, erythrocyte, and leukocyte concentrations as dependent variables. Platelet concentration was analyzed with ANOVA and t-test; erythrocytes and leukocytes concentration with Kruskal Wallis and Mann Whitney test. Platelet concentration was higher in P3 and P4 than in P1 (P < 0.0009) and equal to P2. P1 presented a lower concentration of erythrocytes than P2, P3, and P4 (P = 0.0014). Leukocytes were observed in all groups. However, P1 had a lower number of leukocytes than P3 and P4 (P = 0.0120) but showed no difference from P2. All groups were identified as being P-PRP and without bacterial contamination. The characterization of quantities and proportions of the blood cells after each protocol will lead to a specific clinical use (intrauterine platelets will aid in persistent post-covering endometritis), since the presence of certain blood cells, can generate different results in tissue proliferation, differentiation, and immunity. Therefore, the P3 and P4 protocols may have advantages in treating reproductive diseases, as the larger volumes make the procedure faster and simpler.

Use of Female External Urinary Catheters in a Burn Intensive Care Unit: Benefits and Challenges.

Burn patients have a relatively high rate of indwelling Foley catheter use because of their need for complex fluid management and wound care. However, Foley catheter use is associated with risks, including urinary tract infection. For female patients, an external urinary catheter is an alternative. To evaluate the use of female external urinary catheters in a burn intensive care unit and to develop a standard protocol. This study involved female patients admitted to a burn intensive care unit from 2017 to 2020. An initiative to increase the use of female external urinary catheters was begun in 2019. A retrospective review of medical records was used to determine rates of indwelling and external catheter use and of catheter-associated urinary tract infection before and after implementation of the initiative. Of 77 female burn patients admitted to the unit between 2019 and 2020, 56 (73%) required indwelling Foley catheterization, a significant decrease from 94% before the initiative (P = .002). The mean duration of indwelling Foley catheter use decreased significantly from 19.4 days to 10.47 days (P = .049). Female external urinary catheters were used in 21 patients (27%). No patients with female external urinary catheters contracted urinary tract infections, compared with 9 patients with indwelling Foley catheters. The use of female external urinary catheters may help reduce the risk of urinary tract infection in female burn patients. Further research is needed to refine the protocol for use of these devices and determine their safety profile.

Radiotherapy and cardiac implantable electronic devices: a nurse-based protocol in a single centre experience

Abstract Funding Acknowledgements Type of funding sources: None. Background An increasing number of patients need cardiac implantable electronic devices (CIED) for bradycardia or to prevent sudden cardiac death. At the same time many patients require radiotherapy for oncologic reasons. Interaction between CIEDs and ionizing radiations may cause several dysfunctions: electromagnetic interferences due to oversensing, CIED reset, drainage of the battery, hardware damage to the pulse generator and to the lead-tissue interface. Purpose An adequate planning is expected to guarantee the safety of CIED patients, reducing the potential complications. We describe our protocol in use and its application. Methods In 2016 an internal protocol was written to standardize the approach to CIED patients undergoing radiotherapy. Cardiology Department, Radiotherapy Unit and Medical Physics were involved in the draft. We stratified patients in high and low risk groups according to the CIED characteristics (ICD vs pacemaker), electro-dependency (yes vs no), and the estimated radiation dose (&amp;lt; 2 Gy: 2-10 Gy, &amp;gt; 10 Gy). Low risk group: - Non pacemaker (PM) dependent patients, estimated dose &amp;lt; 10 Gy - PM dependent patients, estimated dose &amp;lt; 2 Gy High risk group: - PM dependent patients, estimated dose &amp;gt; 2 Gy - Non-PM dependent patients estimated dose &amp;gt;10 Gy - ICD patients Two EHRA certificated nurses followed up the patients before, during and after the radiotherapy. Low risk patients received weekly in office evaluation during radiotherapy course. High risk patients were scheduled for daily in office check plus monitoring during each radiotherapy session, ICD therapy was temporarily switched off during each radiotherapy session. An in office evaluation was planned 1, 3, 6 and 12 months after the end of radiotherapy course until 2019, since 2020 all patients were given remote monitoring for accurate follow up. Results Between 2016 and November 2022 101 patients with CIED underwent radiotherapy in our facility. Clinical characteristics of the patients are described in Table 1. EHRA certificated nurses managed 1282 radiotherapy sessions without any complication. A transient underestimation of ICD longevity was the only software error occurred. Conclusions The reported protocol assured a safe radiotherapy course for all our CIED patients. Given the limited data available about the interaction between the newest CIEDs and radiotherapy, we opted for a high safety profile. The EHRA certified nurse’s involvement allowed to optimize personnel resources.

Persuasive: A node isolation attack variant for OLSR-based MANETs and its mitigation

Mobile ad hoc networks (manets) are self-creating, self-configuring, self-healing, decentralized adaptive networks. The Optimized Link State Routing protocol (olsr) is one of four base routing protocols for use in ad hoc networks. manet’s routing protocols, however, are vulnerable to various attacks. In this paper we introduce persuasive, a new, sophisticated and devastating node isolation attack variant against the olsr protocol. This attack allows for an attacker model with enhanced capabilities. We then present a novel technique to mitigate persuasive. The technique guarantees protection for all feasible topologies, incuring only local (centered around the attacker) and relatively-low overhead, independent of the network’s topology. Our new protection mechanism does not disclose its activity to the attacker, and does not impose any network overhead if an attack is not launched. The novelty of the current approach is rooted in the fact that only inherent capabilities of the olsr protocol are used. This allows for quiet discovery of the adversary, and easy integration with deployed systems. We simulate persuasive and its mitigation with ns3, comparing it with several state-of-the-art protection alternatives. We show that launching persuasive in a dynamic network while our mitigation mechanism is activated, will not only fend off the attack with success rates running between 93% for small networks and 100% for larger ones, but also enhance the victim’s connectivity. It is shown that the average end-to-end delay incurred is also better than existing alternatives, and only slightly worse than native olsr (without any protection).

Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions

Introduction Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain. ERAS components ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast. Conclusion ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.

Simplified screening and referral protocol for sinonasal mucormycosis in post COVID-19 patients

BackgroundTo study incidence of sinonasal mucormycosis in active and post COVID-19 patients in a district-level hospital in India and develop a simplified screening and referral protocol for use at peripheral centres to aid rapid diagnosis/treatment.MethodsStudy design: A prospective, interventional cohort study conducted from April 2021 to January 2022. Setting: Secondary level hospital in North India. Inclusion criteria: COVID-19 positive patients with diabetes mellitus as co-morbidity and with at least one of the following: received steroid therapy and/or on high flow oxygen therapy and/or had prolonged hospital stay (> 7 days). Exclusion criteria: Patients already immunocompromised/having malignancy/organ transplant recipients. Clinical workup: History, examination, imaging (CECT/MRI nose and paranasal sinuses if indicated), diagnostic nasal endoscopy + Nasal scrapings for KOH mount to detect fungal elements. STROBE guidelines were followed in the study.ResultsFourteen out of 250 patients tested positive for mucormycosis (incidence 5.6%). Thirteen were symptomatic, one patient was asymptomatic and detected on screening. No significant difference was found in mucormycosis versus non-mucormycosis group with respect to HbA1c status, vaccination status or steroid + oxygen treatment (p > 0.05 in all scenarios). Patients were treated with intravenous liposomal amphotericin B and surgical debridement when indicated. Two succumbed to disease (survival 85.7%). A clinical screening protocol was thus developed which can be used as an effective tool even at far-flung and remote healthcare facilities for diagnosis and timely referral of patients.ConclusionsMucormycosis is a potentially lethal disease which needs rapid diagnosis and timely action to decrease morbidity and mortality.

Does stoma modify compliance with enhanced recovery after surgery programs? Results of a cohort study

Few studies have focused on enhanced recovery programs (ERPs) in patients who have received a stoma after colorectal surgery. The objective of the study was to compare ERP compliant patients who have not received a stoma, those who received a colostomy, and those who received an ileostomy. This study used data that had been prospectively collected as part of the ERP audit performed through the Groupe francophone de Réhabilitation Améliorée après Chirurgie [Francophone Group for Enhanced Recovery after Surgery] over a 4-year period. All patients who had undergone colorectal surgery were included and separated into three groups (no stoma, ileostomy, and colostomy). The primary outcome was ERP compliance, calculated through the use of 16 tracer items. Of the 422 recruited patients, 317 had not received a stoma (75.12%), 59 had an ileostomy (13.98%), and 46 had a colostomy (10.90%). ERP compliance was 73% in the non-stoma group, 66.6% in the ileostomy group, and 66% in the colostomy group (p < 0.001). Multivariate analysis showed that patients from the ileostomy group had a higher risk of bowel preparation [OR = 9.1; 95% CI = 1.16-71.65] and of maintaining their urinary catheter [OR = 0.3; 95% CI = 0.14-0.81] than the group which did not receive a stoma. Patients from the colostomy group required significantly more drainage than those in the non-stoma group (OR = 4.3; 95% CI = 1.33-14.02). ERP is feasible in colorectal surgery in the context of stomas, but in case of ileostomy protecting a rectal surgery, the audit system must be adapted to the protocols in use in the departments.

Rational design of a survey protocol for avocado sunblotch viroid in commercial orchards to demonstrate pest freedom.

Avocado sunblotch viroid (ASBVd) is a subcellular pathogen of avocado that reduces yield from a tree, diminishes the appearance of the fruit by causing unsightly scarring and impedes trade because of quarantine conditions that are imposed to prevent spread of the pathogen via seed-borne inoculum. For countries where ASBVd is officially reported, permission to export fruit to another country may only be granted if an orchard can be demonstrated to be a pest free production site. The survey requirements to demonstrate pest freedom are usually defined in export protocols that have been mutually agreed upon by the trading partners. In this paper, we introduce a flexible statistical protocol for use in optimizing sampling strategies to establish pest free status from ASBVd in avocado orchards. The protocol, which is supported by an interactive app, integrates statistical considerations of multistage sampling of trees in orchards with a RT-qPCR assay allowing for detection of infection in pooled samples of leaves taken from multiple trees. While this study was motivated by a need to design a survey protocol for ASBVd, the theoretical framework and the accompanying app have broader applicability to a range of plant pathogens in which hierarchical sampling of a target population is coupled with pooling of material prior to diagnosis.

Thermo-mechanical numerical analyses in support of fire endurance assessment of ordinary soda-lime structural glass elements

PurposeGlass material is largely used for load-bearing components in buildings. For this reason, standardized calculation methods can be used in support of safe structural design in common loading and boundary conditions. Differing from earlier literature efforts, the present study elaborates on the load-bearing capacity, failure time and fire endurance of ordinary glass elements under fire exposure and sustained mechanical loads, with evidence of major trends in terms of loading condition and cross-sectional layout. Traditional verification approaches for glass in cold conditions (i.e. stress peak check) and fire endurance of load-bearing members (i.e. deflection and deflection rate limits) are assessed based on parametric numerical simulations.Design/methodology/approachThe mechanical performance of structural glass elements in fire still represents an open challenge for design and vulnerability assessment. Often, special fire-resisting glass solutions are used for limited practical applications only, and ordinary soda-lime silica glass prevails in design applications for load-bearing members. Moreover, conventional recommendations and testing protocols in use for load-bearing members composed of traditional constructional materials are not already addressed for glass members. This paper elaborates on the fire endurance and failure detection methods for structural glass beams that are subjected to standard ISO time–temperature for fire exposure and in-plane bending mechanical loads. Fire endurance assessment methods are discussed with the support of Finite Element (FE) numerical analyses.FindingsBased on extended parametric FE analyses, multiple loading, geometrical and thermo-mechanical configurations are taken into account for the analysis of simple glass elements under in-plane bending setup and fire exposure. The comparative results show that – in most of cases – thermal effects due to fire exposure have major effects on the actual load-bearing capacity of these members. Moreover, the conventional stress peak verification approach needs specific elaborations, compared to traditional calculations carried out in cold conditions.Originality/valueThe presented numerical results confirm that the fire endurance analysis of ordinary structural glass elements is a rather complex issue, due to combination of multiple aspects and influencing parameters. Besides, FE simulations can provide useful support for a local and global analysis of major degradation and damage phenomena, and thus support the definition of simple and realistic verification procedures for fire exposed glass members.

PD06-08 TAKING THE SUBJECTIVITY OUT OF INTRAOPERATIVE MANAGEMENT OF TESTICULAR TORSION: CREATING A STANDARDIZED PROTOCOL FOR USE OF INDOCYANINE GREEN

You have accessJournal of UrologyCME1 Apr 2023PD06-08 TAKING THE SUBJECTIVITY OUT OF INTRAOPERATIVE MANAGEMENT OF TESTICULAR TORSION: CREATING A STANDARDIZED PROTOCOL FOR USE OF INDOCYANINE GREEN Amanda Raines, Nicolas Fernandez, Jennifer Ahn, Mark Cain, Byron Joyner, Kathleen Kieran, Paul Merguerian, Hailey Silverii, and Margarett Shnorhavorian Amanda RainesAmanda Raines More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Paul MerguerianPaul Merguerian More articles by this author , Hailey SilveriiHailey Silverii More articles by this author , and Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The current standard of care to determine testicular viability in testicular torsion is surgeon’s subjective assessment. Studies on objective means to assess testicular perfusion after detorsion are lacking. Indocyanine green (ICG) is a fluorescent dye which has been widely used to evaluate tissue perfusion. To date use of ICG in testicular torsion has been limited to case reports with no series or protocols yet published. We aimed to develop and implement a standardized protocol for the use of ICG in testicular torsion and evaluate the effectiveness of ICG as an objective tool to assess testicular perfusion. METHODS: This was a single institution pilot study on the use of ICG in testicular torsion. A useable standardized protocol for use of ICG in testicular torsion was developed and implemented. The Stryker SPY PHI system and novel quantification software, SPY-QP, were used for ICG imaging. The protocol development was an adaptive process. The finalized protocol is detailed in Figure 1. RESULTS: ICG was used in 17 cases of testicular torsion with 13 undergoing orchiopexy and 4 undergoing orchiectomy. Of the 4 testes which were removed, we noted no to very low ICG uptake with SPY-QP measurements of 0-7% when compared to a mean ICG uptake in the orchiopexy group of 74.5% (p= 0.003) (Table 1). The pathology of all four showed hemorrhagic necrosis. At early post operative follow up there was no evidence of testicular atrophy in those that underwent orchiopexy. There were no intraoperative complications or adverse reactions to ICG. CONCLUSIONS: Our institution successfully developed and implemented a standardized protocol for ICG use in testicular torsion. Early results indicate our protocol provides objective and quantitative assessment of testicular perfusion. We think this technology is a useful adjunct in the surgical management of testicular torsion and can aid in surgical decision making particularly in equivocal cases. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Nicolas Fernandez More articles by this author Jennifer Ahn More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Paul Merguerian More articles by this author Hailey Silverii More articles by this author Margarett Shnorhavorian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL

You have accessJournal of UrologyCME1 Apr 2023MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL Amanda Raines, Jennifer Ahn, Nicolas Fernandez, Mark Cain, Byron Joyner, Kathleen Kieran, Margarett Shnorhavorian, and Paul Merguerian Amanda RainesAmanda Raines More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While we know blood supply to catheterizable channels is important to their long term success, there is currently no objective means to assess perfusion. Indocyanine green has a well established use in the evaluation of bowel perfusion, however, use has not been reported in catheterizable channels. Our aims were to develop a standardized protocol for using ICG in the creation of catheterizable channels and establish perfusion patterns of the channels. METHODS: A standardized protocol for the use of ICG in catheterizable channel creation was developed in an adaptive process in this single institution pilot study. Stryker’s SPY PHI system and SPY-QP quantification system were used. SPY-QP allowed for quantification of ICG uptake in the channel relative to healthy bowel. The standardized protocol is described in figure 1. RESULTS: ICG was used in the creation of 3 new appendicovesicostomies and 1 channel revision. Overall, perfusion to the channel decreased with increasing mobilization, but degree of decrease varied between patients. The median ICG uptake went from 85.5% immediately after stapling the appendix to 63.5% when examining the subfascial channel after maturing and 27% at the stoma. In the one revision, ICG clearly delineated an area of poor perfusion in the distal channel after complete mobilization of the channel off the skin and fascial attachments. CONCLUSIONS: The standardized protocol for use in catheterizable channels was successfully implemented. In the channel revision, ICG clearly delineated the area of distal hypoperfusion after channel takedown. ICG can provide surgeons with an objective assessment of channel perfusion rather than relying on subjective assessment alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e228 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Jennifer Ahn More articles by this author Nicolas Fernandez More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Margarett Shnorhavorian More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...

Problems of standardizing agent-based model description and possible ways to solve them

The problem of standardizing the description of agent-based models is considered. The foreign experience in solving this problem is studied in detail, and the authors' developments are proposed. In the course of this study, a critical analysis of the existing standards (the original ODD protocol and its updates and modifications) was carried out. An adapted translation of the ODD protocol for use in Russian-language publications was proposed. The need to develop a separate standard for describing agent-based models intended for approbation of management decisions was substantiated. The structure of the standard was proposed, and the prospects for its application were described. The scientific novelty and practical significance of this study consists in the development and justification of the first Russian-language standard for describing agent-based models with account for domestic experience, terminology, and the best examples of models’ description, as well as in the proposal to create an open registry of applied models that would provide interaction with potential users of agent-based decision support systems developed by research teams.

Problems related to oxygenotherapy in hospitalised adults: a systematic review

Objectives and methods: The objective of this study was to identify problems related to oxygen therapy in hospitalized adults in the literature. The systematic review was developed to identify problems related to oxygen therapy in hospitalised adults and classify them by means of an expert panel using the Pharmaceutical Care Network Europe, version 9.1. Results: Of the 2,618 articles initially identified for the systematic review, 18 met the eligibility criteria, of which five were carried out in Australia (5/18; 27.7%), and the most frequent study design was clinical trial (5/18; 27.7%). An analysis by the expert panel identified hyperoxia as the main cause of patients’ problems (17/18; 94.4%), and no DRP (drug-related problem) was classified as P1.1 (no treatment effect medication, despite the correct use) or P3.2 (unclear problem or complaint: further clarification is required). Studies show that problems related to oxygen therapy are mostly associated with high doses, often caused by failures in the care process such as errors in prescriptions and failures in administration and monitoring of use. Conclusions: the results reinforce the need for the involvement of all members of the multidisciplinary team in the care of patients on oxygen. In addition, the role of the pharmacist in establishing protocols for use with the team, in the standardisation of the system for prescribing medicinal gases, in the validation of medical prescriptions, and in the pharmacotherapeutic follow-up can contribute to the quality and safety of the services provided by health institutions.

Towards a Diagnostic Tool for Turtle Ootaxonomy: Investigation of Microstructural Differences in the Eggshells of Australian Freshwater Turtles

Researchers frequently encounter turtle nests after the nest has been raided, finding only eggshell fragments that are difficult to identify. Valuable information on the breeding biology and needs of different species might still be collected from these nests if remains could be confidently assigned to a particular species. However, this can be difficult if there are multiple turtle species nesting within an area at a given time, and gross-scale characteristics such as egg size and shape are no longer available due to damage. This study examined eggshell microstructure, by scanning electron microscopy (SEM), among multiple species of freshwater turtle eggshell fragments, with the aim of potentially developing a diagnostic tool for species identification. Eggshell fragments were collected from known sources of four species of turtle native to eastern Australia: Eastern Long-necked Turtle (Chelodina longicollis), Murray River Turtle (Emydura macquarii), Bell's Turtle (Myuchelys bellii), and Bellinger River Turtle (M. georgesi). Fragments were scanned and analyzed for microstructural and ultrastructural features, and measured for differences in feature size across species. Central plaque diameter emerged as a potential diagnostic feature for separating species, with longneck turtle eggshells having no visible plaques, Murray River Turtle eggshells having relatively small mean plaque size (19.8 µm ± 10.28 SD), while Bell's Turtle (43.5 µm ± 14.16 SD) and Bellinger River Turtle eggshells (41.9 µm ± 15.41 SD) had relatively large plaques with little overlap between genera. Other measured features (shell unit size, basal knob size, and shell unit density) significantly differed in means among species but overlapped in range, or showed a lack of statistical difference, likely preventing the technique being definitive with a single measure. Some of this variance may be due to inherent confounding factors, such as the replicability of fragment preparation, condition of eggshells, and stage of embryonic development at the time of collection. These results suggest that use of measurements of microstructural features has promise as a means for distinguishing the provenance of eggshell fragments, and further investigation is warranted to develop site-specific protocols for use as a diagnostic tool for turtle ootaxonomy.